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Exposing the Facade: Nonprofit Exploitation and Betrayal in the Institute for Family Health

Management at the Institute for Family Health (IFH), a prominent non-profit health organization in New York City, has threatened to take away healthcare worker benefits if they don’t close medical charts in a specified timeframe. IFH’s decision not only reflects the capitalist logic employed by for-profit companies, but also highlights how nonprofit organizations reproduce this logic and function to uphold the capitalist system.

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Recently the Institute for Family Health (IFH), a nonprofit clinic in New York City, has shown its true colors through a leaked document distributed to employees. The document entitled “Delinquent Encounters Corrective Action Plans” was distributed by IFH Vice President and Chief Marketing Officer Eric Gayle, and outlines a decision that threatens to strip healthcare workers of their benefits and suspend them from work if they fail to close medical charts within a particular time frame. Per Gayle, these measures are set to take effect July 1, 2023. Those workers who have medical encounters not closed for over 14 days will risk the following (shown in a screenshot from the document below): 

The document goes on to say that “Residents and learners who similarly have open encounters over 14 days will be responded to in a similar manner consistent with their training responsibilities.” Residents often work extremely grueling schedules, alternating between hospital and clinic responsibilities, making this threat particularly cruel. 

These measures are especially hypocritical coming from an organization that claims to prioritize social justice. Per IFH’s online mission statement, “The mission of the Institute for Family Health is to provide high quality, patient-centered primary health care in communities historically neglected due to racism and poverty, regardless of patients’ ability to pay.” The statement goes on to say the Institute “commits to eliminating racism within our organization, and advocates for equity and justice by changing policies and practices that negatively impact our employees and patients.”

Despite these lofty claims, by treating healthcare workers as mere instruments of productivity, the IFH perpetuates a system that values efficiency over workers’ rights, ultimately exploiting their labor to maximize output and reducing healthcare workers to disposable commodities. The organization’s executives issuing these threats embody the exact principles their organization claims to confront. Instead of “changing policies and practices that negatively impact our employees,” they actively create them.

IFH management has long claimed that unclosed charts are negatively affecting the economic status of the organization which prides itself in caring for some of the most marginalized in New York City. This claim is comical when analyzed in the context that the same individual who issued this threat via email, Gayle, makes more than $290,000 annually, according to 2021 tax filings. IFH CEO, Neil Calman makes over $750,000 in total compensation, while Senior Vice President and Chief Academic Officer Red Schiller makes over $450,000 annually. The organization’s management claims the organization is struggling financially, necessitating it to have to threaten its workers with these measures they’ve been forced into imposing, yet it somehow finds a way to pay these individuals exorbitant sums.

These recent threats are by no means the first time IFH management has put productivity over the needs of workers or patients. During the beginning of the Covid-19 pandemic, IFH management made the decision to create a “point system” which would assign “point numbers” to patients as part of an effort to speed up visits. The more points providers accrued, the higher their compensation — as if in some kind of video game. Inevitably, this system to speed up visits led to poorer patient care. 

At the time, one of the authors was in residency training and became part of an organized group of healthcare workers of all clinical levels called “The People’s IFH” which was demanding the end to the point system, financial transparency, and collective management of the clinic by the workers themselves. IFH management went on the offensive, making backdoor deals with certain sectors of the workforce and fighting against organizing efforts. 

Today, history is repeating itself: management is reproducing similar policies, despite past promises against taking such measures ever again.

Nonprofits Under Capitalism

IFH is by no means exceptional in the nonprofit sector. Under capitalism, the relentless pursuit of profit infiltrates every corner of society — including most nonprofit organizations, which often claim to support progressive causes. The leaked document from the IFH showcases their adoption of the same exploitative practices utilized by for-profit corporations. The decision underscores the inherent contradiction between the nonprofit label and the actions taken by such organizations.

Nonprofits serve as a key sector to help uphold the capitalist system. As we have covered, following the gutting of an already broken welfare state in the 1970s, nonprofits began to provide, at least partially, services which should be provided by the state. This means that “the budgets of federal, state and municipal government can be cut and corporate taxes and taxes on the ultrarich can be slashed.” Over time, this process has aided in conditioning the public to see these services “not as the rightful responsibility of the state but as gifts from ‘generous’ capitalists and corporations” as a form of charity to various organizations. Ultimately, by gearing individuals to donate to nonprofits to provide services that should be provided by the state, the process also impedes the working class from uniting with its most marginalized members for liberation.

Often, workers who are politically conscious join nonprofits because of their progressive missions. Often these include combating racism, reducing poverty, or “caring for communities historically neglected” as IFH’s mission claims. The state even gives incentives to coax people into joining nonprofits through programs such like Public Service Loan Forgiveness (PSLF).   But once inside of these organizations, workers often find many of these same dynamics of for-profit companies reproduced: hierarchical management structures, job insecurity, exorbitant compensation for company leadership, anti-union sentiment, among others. Efforts that could go into destabilizing capitalism eventually go into expanding the nonprofit organizationally. In this way, nonprofits can serve to ideologically condition more militant workers directing their efforts into the organization instead of outside the organization more broadly.

Nonprofits often address the downstream effects of the violent system of capitalism, without actually confronting the system itself. This presents a contradiction within these organizations: they claim to want to address poverty, inequality, and other social ills, but can only go so far “upstream” in their efforts to address these conditions. The nonprofit logic “centers not on challenging the existing system but rather on negotiating with the political establishment for slightly improved conditions.” Efforts of workers go into, for example, “lobbying” the capitalist politicians for crumbs, while presenting said efforts as “challenging those in power.” But these dynamics push nonprofits by their very nature toward making compromises with the capitalist state, instead of finding ways to destabilize it —  ultimately seeking to integrate into, rather than disrupt, a system which actually creates these issues. Nonprofit organizations such as IFH, despite no shortage of progressive rhetoric, function to uphold the capitalist system. 

A New Way Forward

The recent memo from IFH management highlights the necessity of healthcare that prioritizes workers’ rights, patient care, and social justice. The decision of IFH management only further underscores the need for healthcare workers to organize themselves in unions or other worker organizations, whether working in for-profit or nonprofit institutions, to defend themselves against management attacks and go on the offensive for better conditions. Moreover, workers must mobilize and fight for their rights by organizing workplace committees and democratic assemblies to decide on their demands and the strategies to achieve them. Organizations such as IFH or other nonprofits should be placed under public ownership, under the management by workers and community members.  

Overall, the example of IFH only further highlights the need for a fundamental transformation of the healthcare system and framework of capitalism as a whole. We need a free, public healthcare system under worker and patient control that ensures universal access to quality care, prioritizes human well-being over profit, and dismantles the exploitative mechanisms ingrained in the capitalist system. This will not come through a nonprofit sector, which ultimately serves to uphold the system — it must come through the self-organization of workers, patients, and communities.

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Mike Pappas

Mike is an activist and medical doctor working in New York City.

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